A Two-Level Identity Model To Support Interoperability of Identity Information in Electronic Health Record Systems.

The sharing and retrieval of health information for an electronic health record (EHR) across distributed systems involves a range of identified entities that are possible subjects of documentation (e.g., specimen, clinical analyser). Contemporary EHR specifications limit the types of entities that can be the subject of a record to health professionals and patients, thus limiting the use of two level models in healthcare information systems that contribute information to the EHR. The literature describes several information modelling approaches for EHRs, including so called “two level models”. These models differ in the amount of structure imposed on the information to be recorded, but they generally require the health documentation process for the EHR to focus exclusively on the patient as the subject of care and this definition is often a fixed one. In this thesis, the author introduces a new identity modelling approach to create a generalised reference model for sharing archetype-constrained identity information between diverse identity domains, models and services, while permitting reuse of published standard-based archetypes. The author evaluates its use for expressing the major types of existing demographic reference models in an extensible way, and show its application for standards-compliant two-level modelling alongside heterogeneous demographics models. This thesis demonstrates how the two-level modelling approach that is used for EHRs could be adapted and reapplied to provide a highly-flexible and expressive means for representing subjects of information in allied health settings that support the healthcare process, such as the laboratory domain. By relying on the two level modelling approach for representing identity, the proposed design facilitates cross-referencing and disambiguation of certain demographics standards and information models. The work also demonstrates how it can also be used to represent additional clinical identified entities such as specimen and order as subjects of clinical documentation

Archetype development and governance methodologies for the electronic health record

[ES] La interoperabilidad semántica de la información sanitaria es un requisito imprescindible para la sostenibilidad de la atención sanitaria, y es fundamental para afrontar los nuevos retos sanitarios de un mundo globalizado. Esta tesis aporta nuevas metodologías para abordar algunos de los aspectos fundamentales de la interoperabilidad semántica, específicamente aquellos relacionados con la definición y gobernanza de modelos de información clínica expresados en forma de arquetipo. Las aportaciones de la tesis son: - Estudio de las metodologías de modelado existentes de componentes de interoperabilidad semántica que influirán en la definición de una metodología de modelado de arquetipos. - Análisis comparativo de los sistemas e iniciativas existentes para la gobernanza de modelos de información clínica. - Una propuesta de Metodología de Modelado de Arquetipos unificada que formalice las fases de desarrollo del arquetipo, los participantes requeridos y las buenas prácticas a seguir. - Identificación y definición de principios y características de gobernanza de arquetipos. - Diseño y desarrollo de herramientas que brinden soporte al modelado y la gobernanza de arquetipos. Las aportaciones de esta tesis se han puesto en práctica en múltiples proyectos y experiencias de desarrollo. Estas experiencias varían desde un proyecto local dentro de una sola organización que requirió la reutilización de datos clínicos basados en principios de interoperabilidad semántica, hasta el desarrollo de proyectos de historia clínica electrónica de alcance nacional.[CA] La interoperabilitat semàntica de la informació sanitària és un requisit imprescindible per a la sostenibilitat de l'atenció sanitària, i és fonamental per a afrontar els nous reptes sanitaris d'un món globalitzat. Aquesta tesi aporta noves metodologies per a abordar alguns dels aspectes fonamentals de la interoperabilitat semàntica, específicament aquells relacionats amb la definició i govern de models d'informació clínica expressats en forma d'arquetip. Les aportacions de la tesi són: - Estudi de les metodologies de modelatge existents de components d'interoperabilitat semàntica que influiran en la definició d'una metodologia de modelatge d'arquetips. - Anàlisi comparativa dels sistemes i iniciatives existents per al govern de models d'informació clínica. - Una proposta de Metodologia de Modelatge d'Arquetips unificada que formalitza les fases de desenvolupament de l'arquetip, els participants requerits i les bones pràctiques a seguir. - Identificació i definició de principis i característiques de govern d'arquetips. - Disseny i desenvolupament d'eines que brinden suport al modelatge i al govern d'arquetips. Les aportacions d'aquesta tesi s'han posat en pràctica en múltiples projectes i experiències de desenvolupament. Aquestes experiències varien des d'un projecte local dins d'una sola organització que va requerir la reutilització de dades clíniques basades en principis d'interoperabilitat semàntica, fins al desenvolupament de projectes d'història clínica electrònica d'abast nacional.[EN] Semantic interoperability of health information is an essential requirement for the sustainability of healthcare, and it is essential to face the new health challenges of a globalized world. This thesis provides new methodologies to tackle some of the fundamental aspects of semantic interoperability, specifically those aspects related to the definition and governance of clinical information models expressed in the form of archetypes. The contributions of the thesis are: - Study of existing modeling methodologies of semantic interoperability components that will influence in the definition of an archetype modeling methodology. - Comparative analysis of existing clinical information model governance systems and initiatives. - A proposal of a unified Archetype Modeling Methodology that formalizes the phases of archetype development, the required participants, and the good practices to be followed. - Identification and definition of archetype governance principles and characteristics. - Design and development of tools that provide support to archetype modeling and governance. The contributions of this thesis have been put into practice in multiple projects and development experiences. These experiences vary from a local project inside a single organization that required a reuse on clinical data based on semantic interoperability principles, to the development of national electronic health record projects.This thesis was partially funded by the Ministerio de Economía y Competitividad, ayudas para contratos para la formación de doctores en empresas “Doctorados Industriales”, grant DI-14-06564 and by the Agencia Valenciana de la Innovación, ayudas del Programa de Promoción del Talento – Doctorados empresariales (INNODOCTO), grant INNTA3/2020/12.Moner Cano, D. (2021). Archetype development and governance methodologies for the electronic health record [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/16491

A RESEARCH ON CHINESE TRADITIONAL ARCHITECTURAL LANDSCAPE IMAGE

Chinese traditional architectural culture is a concernful component in the national cultural heritage, in which the traditional architectural landscape undergoes historical aggradation in hundred and thousand years, becoming corporate works of traditonal culture and nature which is the most research content of Chinese architectural history and modern cultural landscape research. The landscape image is formed by the abstractive cognition to the concrete environmental which fused of the common cultural characteristics of ‘image thinking’ and idea in landscape forming and cultural significance in perception and assessment. It is a concernful vector which reflects the unique traditional landscape culture. Therefore, to study the traditional architectural landscape image is an approach of research on the cultural inheritance and development, especially in cultural landscape horizon, is a important content in research system of landscape cultural synthesis. It takes the traditional architectural landscape image to be research object. Through the analysis on the thinking process of constitutive and perceived landscape. The idiosyncracy of significance is formed by the image counsciousness and implication perception. The idiosyncracy of image is formed by the imaginary image with cultural characteristics and derivative objective image.It forms a research structure of landscape image and analyzes the characteristics in uesd of the compared qualitative methods in multiple dimensions and landscape assessment qualitative methods. It purposes to analyze the cultural consciousness basis, the thought medium of landscape archetype and archetypal image, the association of cultural coding and decoding in implication perception.It reflects the time-space characteristics and interprets the thought characteristics of landscape image. It uses the archetypal theory of Carl jung and “image thinking” as the theories of the research on the thought characteristics of tectonic landscape consciousness and concept of images. Through the analysis of the tectonic landscape thought, it forms the construction of landscape consciousness and analyzes the landscape analogue image thinking of psychology, demands and experience together with the multi-element composite and diffusion derivative aspects. It proposes two landscape archetypes which forms imagination, discusses the landscape thought in traditional culture of classify imagination and typical archetypal image and space configuration of set integration. It purposes to interpret the cognitive law of consciousness and idea. According to the point of the imagination presented by substance, it analyzes the space derivation and momentums characterization which attempts to form a connected research system of consciousness, imagination and objective image.Based on the space types and the typical landscape instance, it extracts the space cognitive image elements from the cognitive image schema by the methods of urban image analysis, Kevin lynch. It analyzes the space configuration of cognitive elements and its logical relationship with tectonic landscape concept. It interprets the characterization of space types and cultural communication which is a research transformation from tectonic landscape image to perceived landscape image. The implication forms based on the space cultural communication so that it analyzes the hierarchical contents, the perceived behavior and cognitive psychology of implication perceived structure. It puts forward an assessment system of perceived image by the mediums of implication perceived factors. It analyzes the property categorys of perceived factors in used of its relations in subjective perception by the methods of questionnaire and software to structure the assessment model of perceived image based on the specific cultural landscape. It interprets the correlation of the tectonic and perceived landscape image which reflects the cultural inheritance and revelatory effect of traditional architectural landscape image. To sum up, a series of issue about the traditional architectural landscape image is explained in new point of view by the cross study including Chinese traditional thought ways, western psychology and landscape assessment. A new study frame of landscape image is constructed by the landscape cultural property and image thought. It analyzes the characteristics of cultural inheritance together with consciousness construction, imaginary characteristics, objective characteristics and implication perceived along with time, space, tectonic in the past and perceived now which attamps to creat a new field with multi-subject of landscape cultural values. It is a further study of Chinese architectural history and a supplement and enrichment of cultural landscape

An Investigation of Semantic Links to Archetypes in an External Clinical Terminology through the Construction of Terminological Shadows

The two-level model based specifications for electronic health record communication EHRcom (ISO 13606) and openEHR both support the embedding of terminological references in Archetypes. This terminological binding can be created manually by a health terminology expert during Archetype design, and the binding is assessed during Archetype evaluation. There has also been some recent work on using lexical queries to generate term sets to represent concepts in Archetypes. This work created an information construct which we call a Terminological Shadow that links Archetype nodes to sets of candidate concepts from a terminology system. The coding scheme used for this work is SNOMED-CT. The proposed Shadows can be used to facilitate the mapping between an Archetype information model and terminological systems. A framework, which also acts as an analysis tool, has been created to construct Shadows from Archetypes. The work also demonstrates how the framework can be used to evaluate different searching algorithms by comparing the search results to the existing bound SNOMED codes

Using the ResearchEHR platform to facilitate the practical application of the EHR standards

Possibly the most important requirement to support co-operative work among health professionals and institutions is the ability of sharing EHRs in a meaningful way, and it is widely acknowledged that standardization of data and concepts is a prerequisite to achieve semantic interoperability in any domain. Different international organizations are working on the definition of EHR architectures but the lack of tools that implement them hinders their broad adoption. In this paper we present ResearchEHR, a software platform whose objective is to facilitate the practical application of EHR standards as a way of reaching the desired semantic interoperability. This platform is not only suitable for developing new systems but also for increasing the standardization of existing ones. The work reported here describes how the platform allows for the edition, validation, and search of archetypes, converts legacy data into normalized, archetypes extracts, is able to generate applications from archetypes and finally, transforms archetypes and data extracts into other EHR standards. We also include in this paper how ResearchEHR has made possible the application of the CEN/ISO 13606 standard in a real environment and the lessons learnt with this experience. © 2011 Elsevier Inc..This work has been partially supported by the Spanish Ministry of Science and Innovation under Grants TIN2010-21388-C02-01 and TIN2010-21388-C02-02, and by the Health Institute Carlos in through the RETICS Combiomed, RD07/0067/2001. Our most sincere thanks to the Hospital of Fuenlabrada in Madrid, including its Medical Director Pablo Serrano together with Marta Terron and Luis Lechuga for their support and work during the development of the medications reconciliation project.Maldonado Segura, JA.; Martínez Costa, C.; Moner Cano, D.; Menárguez-Tortosa, M.; Boscá Tomás, D.; Miñarro Giménez, JA.; Fernández-Breis, JT.... (2012). Using the ResearchEHR platform to facilitate the practical application of the EHR standards. Journal of Biomedical Informatics. 45(4):746-762. doi:10.1016/j.jbi.2011.11.004S74676245

A Two-Level Information Modelling Translation Methodology and Framework to Achieve Semantic Interoperability in Constrained GeoObservational Sensor Systems

As geographical observational data capture, storage and sharing technologies such as in situ remote monitoring systems and spatial data infrastructures evolve, the vision of a Digital Earth, first articulated by Al Gore in 1998 is getting ever closer. However, there are still many challenges and open research questions. For example, data quality, provenance and heterogeneity remain an issue due to the complexity of geo-spatial data and information representation. Observational data are often inadequately semantically enriched by geo-observational information systems or spatial data infrastructures and so they often do not fully capture the true meaning of the associated datasets. Furthermore, data models underpinning these information systems are typically too rigid in their data representation to allow for the ever-changing and evolving nature of geo-spatial domain concepts. This impoverished approach to observational data representation reduces the ability of multi-disciplinary practitioners to share information in an interoperable and computable way. The health domain experiences similar challenges with representing complex and evolving domain information concepts. Within any complex domain (such as Earth system science or health) two categories or levels of domain concepts exist. Those concepts that remain stable over a long period of time, and those concepts that are prone to change, as the domain knowledge evolves, and new discoveries are made. Health informaticians have developed a sophisticated two-level modelling systems design approach for electronic health documentation over many years, and with the use of archetypes, have shown how data, information, and knowledge interoperability among heterogenous systems can be achieved. This research investigates whether two-level modelling can be translated from the health domain to the geo-spatial domain and applied to observing scenarios to achieve semantic interoperability within and between spatial data infrastructures, beyond what is possible with current state-of-the-art approaches. A detailed review of state-of-the-art SDIs, geo-spatial standards and the two-level modelling methodology was performed. A cross-domain translation methodology was developed, and a proof-of-concept geo-spatial two-level modelling framework was defined and implemented. The Open Geospatial Consortium’s (OGC) Observations & Measurements (O&M) standard was re-profiled to aid investigation of the two-level information modelling approach. An evaluation of the method was undertaken using II specific use-case scenarios. Information modelling was performed using the two-level modelling method to show how existing historical ocean observing datasets can be expressed semantically and harmonized using two-level modelling. Also, the flexibility of the approach was investigated by applying the method to an air quality monitoring scenario using a technologically constrained monitoring sensor system. This work has demonstrated that two-level modelling can be translated to the geospatial domain and then further developed to be used within a constrained technological sensor system; using traditional wireless sensor networks, semantic web technologies and Internet of Things based technologies. Domain specific evaluation results show that twolevel modelling presents a viable approach to achieve semantic interoperability between constrained geo-observational sensor systems and spatial data infrastructures for ocean observing and city based air quality observing scenarios. This has been demonstrated through the re-purposing of selected, existing geospatial data models and standards. However, it was found that re-using existing standards requires careful ontological analysis per domain concept and so caution is recommended in assuming the wider applicability of the approach. While the benefits of adopting a two-level information modelling approach to geospatial information modelling are potentially great, it was found that translation to a new domain is complex. The complexity of the approach was found to be a barrier to adoption, especially in commercial based projects where standards implementation is low on implementation road maps and the perceived benefits of standards adherence are low. Arising from this work, a novel set of base software components, methods and fundamental geo-archetypes have been developed. However, during this work it was not possible to form the required rich community of supporters to fully validate geoarchetypes. Therefore, the findings of this work are not exhaustive, and the archetype models produced are only indicative. The findings of this work can be used as the basis to encourage further investigation and uptake of two-level modelling within the Earth system science and geo-spatial domain. Ultimately, the outcomes of this work are to recommend further development and evaluation of the approach, building on the positive results thus far, and the base software artefacts developed to support the approach

DETAILED CLINICAL MODELS AND THEIR RELATION WITH ELECTRONIC HEALTH RECORDS

Tesis por compendio[EN] Healthcare domain produces and consumes big quantities of people's health data. Although data exchange is the norm rather than the exception, being able to access to all patient data is still far from achieved. Current developments such as personal health records will introduce even more data and complexity to the Electronic Health Records (EHR). Achieving semantic interoperability is one of the biggest challenges to overcome in order to benefit from all the information contained in the distributed EHR. This requires that the semantics of the information can be understood by all involved parties. It has been stablished that three layers are needed to achieve semantic interoperability: Reference models, clinical models (archetypes), and clinical terminologies. As seen in the literature, information models (reference models and clinical models) are lacking methodologies and tools to improve EHR systems and to develop new systems that can be semantically interoperable. The purpose of this thesis is to provide methodologies and tools for advancing the use of archetypes in three different scenarios: - Archetype definition over specifications with no dual model architecture native support. Any EHR architecture that directly or indirectly has the notion of detailed clinical models (such as HL7 CDA templates) can be potentially used as a reference model for archetype definition. This allows transforming single-model architectures (which contain only a reference model) into dual-model architectures (reference model with archetypes). A set of methodologies and tools has been developed to support the definition of archetypes from multiple reference models. - Data transformation. A complete methodology and tools are proposed to deal with the transformation of legacy data into XML documents compliant with the archetype and the underlying reference model. If the reference model is a standard then the transformation is a standardization process. The methodologies and tools allow both the transformation of legacy data and the transformation of data between different EHR standards. - Automatic generation of implementation guides and reference materials from archetypes. A methodology for the automatic generation of a set of reference materials is provided. These materials are useful for the development and use of EHR systems. These reference materials include data validators, example instances, implementation guides, human-readable formal rules, sample forms, mindmaps, etc. These reference materials can be combined and organized in different ways to adapt to different types of users (clinical or information technology staff). This way, users can include the detailed clinical model in their organization workflow and cooperate in the model definition. These methodologies and tools put clinical models as a key part of the system. The set of presented methodologies and tools ease the achievement of semantic interoperability by providing means for the semantic description, normalization, and validation of existing and new systems.[ES] El sector sanitario produce y consume una gran cantidad de datos sobre la salud de las personas. La necesidad de intercambiar esta información es una norma más que una excepción, aunque este objetivo está lejos de ser alcanzado. Actualmente estamos viviendo avances como la medicina personalizada que incrementarán aún más el tamaño y complejidad de la Historia Clínica Electrónica (HCE). La consecución de altos grados de interoperabilidad semántica es uno de los principales retos para aprovechar al máximo toda la información contenida en las HCEs. Esto a su vez requiere una representación fiel de la información de tal forma que asegure la consistencia de su significado entre todos los agentes involucrados. Actualmente está reconocido que para la representación del significado clínico necesitamos tres tipos de artefactos: modelos de referencia, modelos clínicos (arquetipos) y terminologías. En el caso concreto de los modelos de información (modelos de referencia y modelos clínicos) se observa en la literatura una falta de metodologías y herramientas que faciliten su uso tanto para la mejora de sistemas de HCE ya existentes como en el desarrollo de nuevos sistemas con altos niveles de interoperabilidad semántica. Esta tesis tiene como propósito proporcionar metodologías y herramientas para el uso avanzado de arquetipos en tres escenarios diferentes: - Definición de arquetipos sobre especificaciones sin soporte nativo al modelo dual. Cualquier arquitectura de HCE que posea directa o indirectamente la noción de modelos clínicos detallados (por ejemplo, las plantillas en HL7 CDA) puede ser potencialmente usada como modelo de referencia para la definición de arquetipos. Con esto se consigue transformar arquitecturas de HCE de modelo único (solo con modelo de referencia) en arquitecturas de doble modelo (modelo de referencia + arquetipos). Se han desarrollado metodologías y herramientas que faciliten a los editores de arquetipos el soporte a múltiples modelos de referencia. - Transformación de datos. Se propone una metodología y herramientas para la transformación de datos ya existentes a documentos XML conformes con los arquetipos y el modelo de referencia subyacente. Si el modelo de referencia es un estándar entonces la transformación será un proceso de estandarización de datos. La metodología y herramientas permiten tanto la transformación de datos no estandarizados como la transformación de datos entre diferentes estándares. - Generación automática de guías de implementación y artefactos procesables a partir de arquetipos. Se aporta una metodología para la generación automática de un conjunto de materiales de referencia de utilidad en el desarrollo y uso de sistemas de HCE, concretamente validadores de datos, instancias de ejemplo, guías de implementación , reglas formales legibles por humanos, formularios de ejemplo, mindmaps, etc. Estos materiales pueden ser combinados y organizados de diferentes modos para facilitar que los diferentes tipos de usuarios (clínicos, técnicos) puedan incluir los modelos clínicos detallados en el flujo de trabajo de su sistema y colaborar en su definición. Estas metodologías y herramientas ponen los modelos clínicos como una parte clave en el sistema. El conjunto de las metodologías y herramientas presentadas facilitan la consecución de la interoperabilidad semántica al proveer medios para la descripción semántica, normalización y validación tanto de sistemas nuevos como ya existentes.[CA] El sector sanitari produeix i consumeix una gran quantitat de dades sobre la salut de les persones. La necessitat d'intercanviar aquesta informació és una norma més que una excepció, encara que aquest objectiu està lluny de ser aconseguit. Actualment estem vivint avanços com la medicina personalitzada que incrementaran encara més la grandària i complexitat de la Història Clínica Electrònica (HCE). La consecució d'alts graus d'interoperabilitat semàntica és un dels principals reptes per a aprofitar al màxim tota la informació continguda en les HCEs. Açò, per la seua banda, requereix una representació fidel de la informació de tal forma que assegure la consistència del seu significat entre tots els agents involucrats. Actualment està reconegut que per a la representació del significat clínic necessitem tres tipus d'artefactes: models de referència, models clínics (arquetips) i terminologies. En el cas concret dels models d'informació (models de referència i models clínics) s'observa en la literatura una mancança de metodologies i eines que en faciliten l'ús tant per a la millora de sistemes de HCE ja existents com per al desenvolupament de nous sistemes amb alts nivells d'interoperabilitat semàntica. Aquesta tesi té com a propòsit proporcionar metodologies i eines per a l'ús avançat d'arquetips en tres escenaris diferents: - Definició d'arquetips sobre especificacions sense suport natiu al model dual. Qualsevol arquitectura de HCE que posseïsca directa o indirectament la noció de models clínics detallats (per exemple, les plantilles en HL7 CDA) pot ser potencialment usada com a model de referència per a la definició d'arquetips. Amb açò s'aconsegueix transformar arquitectures de HCE de model únic (solament amb model de referència) en arquitectures de doble model (model de referència + arquetips). S'han desenvolupat metodologies i eines que faciliten als editors d'arquetips el suport a múltiples models de referència. - Transformació de dades. Es proposa una metodologia i eines per a la transformació de dades ja existents a documents XML conformes amb els arquetips i el model de referència subjacent. Si el model de referència és un estàndard llavors la transformació serà un procés d'estandardització de dades. La metodologia i eines permeten tant la transformació de dades no estandarditzades com la transformació de dades entre diferents estàndards. - Generació automàtica de guies d'implementació i artefactes processables a partir d'arquetips. S'hi inclou una metodologia per a la generació automàtica d'un conjunt de materials de referència d'utilitat en el desenvolupament i ús de sistemes de HCE, concretament validadors de dades, instàncies d'exemple, guies d'implementació, regles formals llegibles per humans, formularis d'exemple, mapes mentals, etc. Aquests materials poden ser combinats i organitzats de diferents maneres per a facilitar que els diferents tipus d'usuaris (clínics, tècnics) puguen incloure els models clínics detallats en el flux de treball del seu sistema i col·laborar en la seua definició. Aquestes metodologies i eines posen els models clínics com una part clau del sistemes. El conjunt de les metodologies i eines presentades faciliten la consecució de la interoperabilitat semàntica en proveir mitjans per a la seua descripció semàntica, normalització i validació tant de sistemes nous com ja existents.Boscá Tomás, D. (2016). DETAILED CLINICAL MODELS AND THEIR RELATION WITH ELECTRONIC HEALTH RECORDS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/62174TESISCompendi

The Lish: A Data Model for Grid Free Spreadsheets

Throughout the history of the spreadsheet, and throughout the majority of research into improving it, the grid of cells has remained a constant as the underlying data model. An idea that has received recent interest is to provide users with a spreadsheet-like environment based on something other than a grid. The attraction is that if salient features of the data structure can be made more explicit, the machine will be able to provide certain types of error checking and automation. In this project I consider one such grid replacement, a new data model which I call the “lish”. It is based on nested lists of cells, composed according to rules that allow repeating structures to be described. It allows columns, tables, groups of tables and other structures to be treated as coherent objects. This supports a novel form of cell range selection, and allows the machine to ensure that related structures are kept consistent. The model is also more accommodating than the grid of dynamic space allocation, where the number of cells occupied by a result is not known in advance. Then, I develop a “lish calculus”, an extension to vector arithmetic for hierarchical structures that provides a concise notation for calculations with lishes. This simplifies the usual spreadsheet formula expressions, and enables the machine to interpret them consistently with the context in which they are located. I evaluate the lish in the framework of the cognitive dimensions of notations, with the help of example use cases and a user study based on a prototype lish editor. These verify many of the hypothesised advantages, but also reveal some difficulties for users. I close with an analysis of how the lish might be revised to address these shortcomings, while continuing to capitalise on the essential benefits